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Clin Infect Dis. 2017 Jan 1;64(1):92-99. Epub 2016 Sep 28.

Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don't Change a Thing.

Author information

1
Duke Clinical Research Institute.
2
Duke University School of Medicine, Durham, North Carolina.
3
Emory University School of Medicine, Atlanta, Georgia.
4
Johns Hopkins School of Medicine, Baltimore, Maryland.

Abstract

Currently, 380 000-400 000 occupational exposures to blood-borne pathogens occur annually in the United States. The management for occupational HIV or hepatitis B virus exposures includes postexposure prophylaxis (PEP) when necessary; however, PEP is not recommended for hepatitis C virus (HCV) exposures. Recent approval of HCV direct-acting antivirals (DAAs) has renewed discussions as to whether these therapies could be used to prevent infection after exposure. There are no published studies addressing this question, but the prescribing of DAAs for PEP has been reported. We will discuss the differences in transmission of the 3 most common blood-borne pathogens, the natural history of early HCV infection, and the scientific rationale for PEP. In particular, we will discuss how the low feasibility of conducting an adequately powered clinical trial of DAA use for PEP and the low cost-effectiveness of such an intervention is not supportive of targeting limited resources for such use.

KEYWORDS:

cost-analysis; direct acting antivirals; hepatitis C virus; occupational exposure; postexposure prophylaxis

PMID:
27682067
PMCID:
PMC5159603
DOI:
10.1093/cid/ciw656
[Indexed for MEDLINE]
Free PMC Article

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